胆道镜下U100激光加利胆排石汤治疗肝内胆管结石

Therapeutic Value of U100 Laser Lithotripsy under Choledochoscopy for Calculi of Intrahepatic Ducts

目的:通过与传统肝切除术及胆肠吻合术比较,探讨胆道镜下U100激光加利胆排石汤对肝内胆管结石的治疗作用。方法:回顾性分析100例通过手术治疗肝内胆管结石患者(行肝切除术33例,胆肠吻合术26例,胆道镜下U100激光碎石加利胆排石汤治疗41例)的临床资料,对比分析各组年龄、术前全身状况(APACHEⅡ评分)、肝功能分级(Child分级)、术后住院天数、结石残余率、术后并发症发生率。结果:3组对比,胆道镜下U100激光碎石加利胆排石汤组术后并发症发生率(2.4%)明显低于肝切除组(18.2%)及胆肠吻合组(19.2%),其结石残余率与肝切除组无明显差异。术后住院时间(15.5±2.9)d明显短于另外两组。肝功能状况(Child分级)及全身状况(APACHEⅡ评分:9.6±1.6分)胆道镜下U100激光碎石加利胆排石汤组均差于另外两组,其患者年龄(平均53.1±10.8岁)高于肝切除组(平均44.1±8.9岁)。结论:胆道镜下U100激光碎石加利胆排石汤组对患者肝功能及全身状况要求较低,是一种简单安全、创伤小、疗效好的方法。

Objective To explore the therapeutic value of U100 laser lithotripsy under choledochoscopy for calculi of intrahepatic ducts with herbal decoction of promoting bile secretion as compared with the results of traditional choledochojejunostomy and of traditional hepatectomy. Methods The results of 100 cases of intrahepatic bile duct stones treated by operation, 33 cases by hepatectomy, 26 cases by choledochojejunostomy and 41 cases by U100 laser lithotripsy under choledochoscopy with herbal decoction of promoting bile secretion were reviewed and analyzed. The patient’s age, postoperative complication and hospitalization, ratio of residual stone, preoperative general conditions （APACHE II scores） and hepatic function （Child’s classification） in each group were respectively compared. Results The postoperative morbidity （2.4%） and the postoperative hospitalization （15.5%±2.9 days） in the group in U100 laser lithotripsy under choledochoscopy with decoction of promoting bile secretion were less than those in the other groups obviously （there was no significant difference between the choledochojejunostomy group and hepatectomy group）. The hepatic function and general conditions were worse than the other groups. The ratio of residual stones was not different in these three groups. Conclusion The operation of U100 laser lithotripsy under choledochoscopy is simple, safe with good therapeutic effect and lower influence to the patient’s general condition and hepatic function.